INTRODUCTION TO TACTICAL COMBAT …

1 INTRODUCTION TO TACTICAL COMBAT CASUALTY CARE SLIDE INSTRUCTIONAL POINTS INSTRUCTOR NOTES 1 TACTICAL COMBAT Casualty Care November 2008 INTRODUCTION TACTICAL COMBAT Casualty Care is the new standard of care in Prehospital Battlefield Medicine. Previous medical training may not have contained the material presented in the following lessons. Medical care in COMBAT is significantly different than that provided on the streets of Anywhere USA. 2 Pre-Test Pass out pre-tests Collect and grade when done Do not take time to review the tests. Tell students the same material will be on the post-test, so now they know what to pay attention to. 3 Objectives As a result of participation in this lesson, participants should be able to: EXPLAIN the differences between military and civilian prehospital trauma care DESCRIBE the key factors influencing COMBAT casualty care UNDERSTAND how TCCC developed DESCRIBE the phases of care in TCCC INTRODUCTION to TACTICAL COMBAT Casualty Care 1 SLIDE INSTRUCTIONAL POINTS INSTRUCTOR NOTES 4 Comparison of Statistics for Battle Casualties, 1941-2005 TCCC has been one of the big developments in the GWOT.

2 The most important measure is how well TCCC does in helping to keep our wounded warriors alive to come home to their families. This study by Army Trauma Surgeon John Holcomb documents that we are now doing that better than ever before. 5 Why Are We Doing Better in Casualty Survival? Improved Personal Protective Equipment TACTICAL COMBAT Casualty Care Faster evacuation time Better trained medics COL Holcomb and his co-authors list TCCC as one of the major reasons for that success. Also kudos to the rest of the chain of care, from the Level II and III hospitals in theater, the evac crews, the staff at Landstuhl, all the way back to the staffs at Walter Reed and Bethesda 6 TCCC This letter is from the Chairman of the Prehospital Subcommittee of the American College of Surgeons Committee on Trauma.

3 The same trauma experts that have established ATLS for managing trauma in the hospital endorses TCCC for battlefield trauma care. 7 Mabry and McManus AMEDD Center and School Major Bob Mabry is the Director of Academics for COMBAT Medic Training at the Army Medical Department Center and School (2008). He used to be an 18D Special Forces medic himself. LTC John McManus is the Director of Predeployment Medical Training for the Army Medical Department Center and School (2008). INTRODUCTION to TACTICAL COMBAT Casualty Care 2 SLIDE INSTRUCTIONAL POINTS INSTRUCTOR NOTES 8 Importance of the First Responder Up to 90% of all COMBAT deaths occur before the casualty reaches a Medical Treatment Facility (MTF) The fate of the injured often lies in the hands of the one who provides the first care to the casualty.

4 Corpsman, Medic, or Pararescueman (PJ) COMBAT Lifesaver or non-medical combatant Prehospital care is the most important aspect in ensuring the survival of the casualty. If the casualty does not arrive alive at the Forward Surgical Team or the COMBAT Support Hospital, then the surgeons skill can t help. There may not be any COMBAT medical personnel available when the casualty occurs. Care may need to be initially provided by the combatant. The goal of TCCC is to identify and treat those casualties with preventable causes of death and keep them alive long enough to reach the hospital. 9 Differences Between Civilian and COMBAT Trauma The causes of trauma are different. The setting in which the trauma occurs is different. The individuals caring for the casualties are different.

5 Evacuation time is typically much longer in the COMBAT setting. Civilian trauma and COMBAT trauma are DIFFERENT in many respects. 10 Epidemiology of civilian trauma This graph shows that civilian trauma is mostly blunt trauma - primarily from automobile accidents. In inner-city areas, there is some penetrating trauma, (stabbings, shootings) but these are the exception rather than the norm. Because of this, the trauma principles associated with EMT, PHTLS, ATLS is focused heavily on blunt trauma. INTRODUCTION to TACTICAL COMBAT Casualty Care 3 SLIDE INSTRUCTIONAL POINTS INSTRUCTOR NOTES 11 How people die in ground COMBAT The three most common causes of preventable death on the battlefield are: Hemorrhage from extremity wounds Tension pneumothorax Airway problems 12 Point of Wounding Care The three most common causes of preventable death on the battlefield are: Hemorrhage from extremity wounds Tension pneumothorax Airway problems These are the injuries that we need to focus on for saving lives in COMBAT .

6 13 Extremity Hemorrhage Play Video Here is a classic example of a preventable cause of death - arterial hemorrhage from an leg wound in a pig). If no one controls this type of bleeding in a casualty, that casualty is going to die very quickly. 14 Tension Pneumothorax This X-ray show a tension pneumothorax, which in COMBAT is usually secondary to a penetrating injury to the chest. This condition may be quickly fatal if not identified and treated. Tension pneumothorax is the SECOND-LEADING cause of preventable death on the battlefield. INTRODUCTION to TACTICAL COMBAT Casualty Care 4 SLIDE INSTRUCTIONAL POINTS INSTRUCTOR NOTES 15 Airway Trauma Deaths from airway trauma are a small percentage of COMBAT fatalities. If the casualty is conscious, he will instinctively protect his own airway.

7 While this patient has a significant injury to his airway, he is able to breath on his own reasonably well if he is sitting up and leaning forward. This casualty survived and did well after reconstructive surgery. Could you lay this casualty down on a littler on his back to transport him? Probably a bad idea - all that blood and mucus would funnel right into his airway. 16 Civilian Trauma Care Setting If you are injured and taken to a civilian trauma center, you will be treated by a skilled team of medical professionals using the latest technology and working in a well-lighted, climate-controlled area. What about trauma that occurs in a TACTICAL COMBAT setting? 17 TACTICAL Trauma Care Setting Shrapnel Wound in the Hindu Kush This is a good example of where the COMBAT corpsmen and medics live and practice.

8 This picture was taken at about 10,000 feet altitude in the Hindu Kush mountains in Afghanistan. The wound is a shrapnel wound of the hip. In this setting, care is much more difficult. It is common sense that the management plan is different here. TCCC helps to define how it s different. INTRODUCTION to TACTICAL COMBAT Casualty Care 5 SLIDE INSTRUCTIONAL POINTS INSTRUCTOR NOTES 18 Factors Influencing Battlefield Casualty Care Hostile fire Darkness Extreme environments Mountain Desert Limited medical equipment Possible prolonged evacuation time Unit s mission TACTICAL flow These are the factors that may interfere with your ability to provide care in the TACTICAL environment. Enemy fire- this is the number one factor that will determine when and how much care you can provide.

9 Darkness, terrain, and environmental factors also will influence your ability to provide care. Medical equipment is limited to whatever is carried in bags and individual first aid kits. Evacuation times and platforms are based primarily on the TACTICAL situation at the time of the evac. Environmental conditions and cause delays in evac as well. Finally, what s happening on the mission will often determine when and how much care can be provided at a given time. 19 Prior Medical Training in the Past COMBAT medical training historically was modeled on civilian courses EMT, PHTLS BTLS, ATLS Trained to standard of care in non- TACTICAL (civilian) settings TACTICAL elements not considered These are the training programs that are used to teach trauma care in the civilian community.

10 They are all EXCELLENT training programs. However, they are designed for the civilian trauma setting - the principles they reflect often need to be modified for the TACTICAL setting. INTRODUCTION to TACTICAL COMBAT Casualty Care 6 SLIDE INSTRUCTIONAL POINTS INSTRUCTOR NOTES 20 Different Trauma Requires Different Care Strategies Common sense, BUT Difficult to devise and implement No one group of medical professionals has all of the skills and experiences necessary. Trauma docs and COMBAT medical personnel have different skill sets. Both are needed to optimize battlefield trauma care strategies. Tourniquets are one striking example of how battlefield trauma care has sometimes been slow to change. TCCC principles are now determined by physicians and COMBAT medical personnel working as a team.